Archived: The Elms Medical Centre

Updated 17 November 2016

The Elms Medical Practice, Whitefield, Bury M45 7FD is located in the Bury Clinical Commissioning Group area. The practice is located in a small purpose built health centre. There is a small car park outside the practice with one disabled bay. There is a local bus service to Bury town centre.

There is one male GP (senior partner) and three female GPs (two partners and one salaried) working at the practice. They work between two and eight sessions per week. There is one female practice nurse who is also a nurse prescriber and health care assistant. There is a practice manager and a team of eight administrative staff.

The practice is a teaching practice for medical students.

The practice is open between 8am and 6pm Monday to Friday. The practice appointment times are between 8.30 am and 12 noon and 2.30 pm and 5.20 pm.

The practice is part of the Bury extended working hours scheme which means patients can access a designated GP service in the Bury area from 6.30pm to 8.00pm Monday to Friday and from 8am to 6pm on Saturdays, Sundays and bank holidays.

Patients requiring a GP outside of normal working hours are advised to call Bury and Rochdale Doctors On Call (BARDOC) using the surgery number and the call will be re-directed to the out-of-hours service.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Updated 17 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Medical Practice on 6 September 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Some significant events were not recorded and minutes sometime held only minimal information. We saw no evidence that an overall analysis of the significant events had taken place.

• Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns. Vulnerable patients including children at risk of harm were not discussed regularly at practice meetings and a record of these meetings was not always kept.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• The comment cards we received indicated that most patients found it easy to make an appointment. Three patients stated in the comment cards that they sometimes found it difficult to book an appointment.

• The practice had facilities and was equipped to treat patients and meet their needs.
• We were told that the practice  proactively  sought feedback from staff and patients, which it acted on. However, a record was not kept of meetings or of discussions held to demonstrate  this had taken place.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• A system of ongoing clinical audit and re-audits must take place in a systematic way to monitor effectiveness of clinical care and improve patient outcomes.
• Clinical staff must provide protection for themselves and their patients when taking blood.

The areas where the provider should make improvement are:

• Significant events should be analysed for the purpose of learning and preventing incidents from recurring.

• A record should always be kept of  meetings held about vulnerable patients including children at risk of harm,  to ensure issues identified are actioned and monitored.

• A record should be kept of medicines held for the purpose of monitoring and auditing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of people with long term conditions. There were however some examples of good practice:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice was part of the Avoiding Unplanned Admissions Enhanced Scheme to support this work.
• 100% of patients on the diabetes register had an influenza immunisation in the preceding 12 months compared to the CCG average of 97% and the national average of 94%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of families, children and young people. There were however some examples of good practice:

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 80% of women aged 25-64 had a cervical screening test had been performed in the preceding 5 years which was similar to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• GPs worked with midwives and health visitors to support expectant mothers.

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of older people. There were however some examples of good practice:

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients over 75 years had a named GP
• The building was accessible for patients with mobility problems via a ramp, a disabled toilet, higher chairs in the waiting room and a bell to ring for assistance with access into the building.

• Flu, pneumococcal and shingles vaccinations were offered to all older patients.

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). There were however some examples of good practice:

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Early morning appointments were available with the nurse and health care assistant.
• Routine GP appointments were available from 8.30am and pre bookable appointments in advance.
• Staff actively promoted NHS health checks. High risk patients were invited to attend NHS health checks and were identified through the IT system.

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). There were however some examples of good practice:

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which compared to the CCG and national averages.
• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 91% and the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice did not always carry out advance care planning for patients with dementia as they were not always identified through their records.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A & E where they may have been experiencing poor mental health.

Updated 17 November 2016

There were aspects of the practice which required improvement and this related to all population groups. The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. There were however some examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• Staff regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Most staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• There was a protocol for uncollected prescriptions to ensure patients received their medicines as prescribed by their GP.
• GPs gained advice from and referred to local services including drug and alcohol services, mental health agencies and dementia services.